Communication obstacles between contracted family doctor team and the disabled / 中华全科医师杂志

Objective:To investigate the status quo of communication between contracted family doctor team and the disabled.Methods:Using convenience sampling, family doctor team members of 80 community health centers (CHCs) in Beijing were selected to participate in a questionnaire survey from April to June 2022. The questionnaire included the basic information of team members, the choice of communication methods and targets, the acquisition of communication knowledge and skills and so on.Results:A total of 365 team members participated in the survey. The most common type of disability was physical disability (78.08%,285/365). All participants met communication obstacles with disabled people in contracted health service, and hearing and speech disabilities were the most common (70.14%, 256/365). Only 13.42% (49/365) chose to directly communicate with the disabled themselves; 84.93% (310/365) used "increase the volume and slow down" method when communicating with the disabled, and 38.63% (141/365) chose "write and convey multiple messages at the same time". Most of participants (84.38%, 308/365) indicated the need for professional training in communication with persons with disabilities.Conclusion:There are communication obstacles between family doctor team members and the disabled during contracted services. More relevant professional training are urgently needed for contracted family doctor team to improve the abilities to communicate with the disabled.

A qualitative study on the feasibility of contracted nursing services for disabled persons / 中华全科医师杂志

Objective:To investigate the feasibility of contracted nursing services for disabled persons.Methods:A qualitative study on the feasibility of contracted nursing services for disabled persons was conducted from August 2020 to October 2020 with the phenomenological method. Community nurses were selected with the purpose of sampling method from Yuetan and Baizhifang Community Health Service Centers in Beijing Xicheng District for semi-constructed interviews, and 12 community nurses were finally interviewed according to the principle of information saturation. The research team took field notes, audio recordings and transcriptions of the interviews, coded to refine the themes, and fed back with the respondents to confirm the accuracy of the themes.Results:All the interviewed nurses thought that the contents of basic medical and public health required by the Guidance manual of contracted services of family doctors for disabled persons (the manual) including basic documentation, appointments, pre-diagnosis and post-diagnosis services, home care, rehabilitation nursing guidance, referral services and extended nursing services for the disabled and their families could be completed. All interviewees said that the manual had a guiding role in contracted services for disabled persons. Eight interviewed nurses believed that the manual involved referral services and rehabilitation care, but the technical guidance content did not meet the actual work needs and it should be supplemented and improved; 9 interviewees pointed out that there was a lack of communication with various types of disabled people in service practice, especially for those with vision, hearing, mental disabilities and disabled children; 7 interviewees said that it the free home care for the disabled was not sustainable. Conclusion:The contracted nursing services for disabled persons are feasible and the manual has a guiding role for the practice,and some contents need to be added in the manual to further improve service capacity for disabled people.

Development of Guiding Manual of Family Doctor Contracting Services for the Disables with Delphi method / 中华全科医师杂志

Objective:To develop a guiding manual of family doctor contracting service for the disabled with Delphi method.Methods:From November 2017 to July 2018, a research group was formed and a survey on the status of family doctor service for disables was conducted in Beijing and other places. After the preliminary outline was formulated, 15 experts from the fields of general practice and rehabilitation for the disabled were invited and 4 rounds of expert consultation were conducted, finally the Guiding Manual of Family Doctor Contracting Service for the Disabled was developed. Results:The authority coefficient of experts was 0.870, and 13, 13, 15 and 15 questionnaires were collected from 15 experts in 4 rounds of consultation, respectively. The W value of Kendall harmony coefficient of the fourth round of expert consultation was 0.394 (χ 2=319.501, P<0.01) and accuracy was 0.234 (χ 2=189.189, P<0.01). After adding and deleting terms by the suggestion and scores of experts, the final draft of the manual is formed, including 5 first-level terms, 15 second-level terms, 18 third-level terms and 17 fourth-level terms. Conclusion:The Guiding Manual of Family Doctor Contracting Service for the Disabled has been developed with Delphi method. Its reliability, validity and practicability need to been further studied.

Effect of intensified electrocardiogram identification by using spectrogram for the enhancing of monitoring and nursing capacity / 中国医学装备

Objective:To explore the effect of intensified electrocardiogram (ECG) identification by using spectrogram for the monitoring and nursing ability of nurses who worked in department of cardiology.Methods: Monitoring and nursing capacity of 120 nurses of cardiology who had been trained on the intensified ECG identification by using spectrogram were researched by retrospective analysis. The 120 nurses were divided into control group (60 cases) and intervention group (60 cases) as the random number table. The nurses of control group only received routine training of ECG identification, while the nurses of intervention group received the training of using spectrogram for ECG identification on basic routine training of control group. A series of indicators, including the scores of ECG comprehensive application ability, identification ability of abnormal electrocardiogram, and the number of the identified abnormal malignance ECG and successfully treated patients, between the two groups were compared and analyzed.Results: After the training, the scores of basic theory, abilities of description and recording, and analysis ability in field operation of the intervention group were significantly higher than those of the control group, respectively (t=11.896,t=8.596,t=8.283,P<0.05). The identified ability including room speed, atrial flutter, ventricular flutter and other abnormal ECG of intervention group were significantly better than these of control group, respectively (x2=18.836,x2=17.698,x2=16.773,P<0.05). Besides, the discovery rate of abnormal malignance ECG (73.3%) and the successful rate of treatment (100.0%)of intervention group were significantly higher than that (31.7% and 81.7%) of control group, respectively (x2=19.184,x2=10.484,P<0.05). Conclusion:The training of intensified ECG identification by using spectrogram for nurse of cardiology can effectively enhance the capacities of identification for ECG and comprehensive application for nurses, and can faster confirm the situation of patient, and can contribute to achieve precision diagnosis for doctors.

Effect of health education on improvement of home caregivers’knowledge and skills on indwelling gastric tube feeding / 现代临床护理

Objective To investigate the effect of health education on the improvement of home caregivers’knowledge and skills on indwelling gastric tube feeding.Methods Fifty home caregivers of senile patients with tube feeding were recruited in the study using a self-designed questionnaire,followed by pertinent health education based on the survey results.The effects of health education were compared between pre-and post-education in terms of their knowledge on tube feeding.Results The total score on knowledge after education was significantly higher than that before education(P<0.001).There were significant improvements in tube feeding temperature,volume,time for tube disinfection and judgment of tube’s place in the stomach after education(all P<0.05). Conclusion Through health education,we could increase the skills of caregivers in caring the patients with tube feeding and thus improve the life quality of these patients.

Effects of treadmill exercise training on biomechanical properties of bone in a rat model of type 2 diabetes / 中华物理医学与康复杂志

Objective To study the influence of different intensities of treadmill exercise training on bone biomechanical properties and the bone healing in type 2 diabetic model rats.Methods Fifty-two healthy 8-month-old male Sprague-Dawley rats were randomly divided into a control group (n =10) and a type 2 diabetic model group (n =42).Type 2 diabetes was modeled in rats of the model group by feeding feedstuff containing high glucose,fat and energy food for 4weeks,followed by a single intra-abdominal injection of streptozotocin.Thirty model rats were then randomized into 3 subgroups:type 2 diabetes group,a mild exercise group and a moderate exercise group.Different intensities of treadmill training protocols was administered accordingly for 8 weeks.The biomechanical indices of the femur bone including maximum load and stress,module and energy was measured with mechanical testing instrument.Results Compared with the control group,both maximum load and energy were decreased significantly in type2 diabetes group [(148.5±17.8)N vs (192.3±43.4)N] for maximum load,and (51.38 ±13.7)mJ vs (82.0 ± 30.8) mJ for maximum stress] (P ＜ 0.05,P ＜ 0.01).Compared with the type 2 diabetes group,maximum load and stress were increased significantly in the mild and moderate exercise groups(P ＜ 0.05,P ＜ 0.01).Maximum load and energy were improved more in the moderate exercise group than in the mild exercise group [(184.1 ± 26.6)N vs (165.4±21.5)N for maximum load and (83.59 ±29.96)mJ vs (62.33 ±14.32)mJ for maximum stress] (P ＜ 0.05).Conclusions A significant decrease of the bone biomechanical properties was observed in rats with experimental type 2 diabetes,which could be alleviated by treadmill exercise training.

The influence of aerobic exercise on the level of advanced glyclation end products in plasma in type 2 diabetic rats / 中华物理医学与康复杂志

Objective To determine the influence of aerobic exercise on advanced glycation end products (AGEs)in plasma using a rat model of type 2 diabetes,and to provide an experimental basis for explaining the rehabilitative mechanism of aerobic exercise in type 2 diabetes.Methods Fifty-two healthy 8-week-old male SpragueDawley rats were allocated at random into a normal control group(n=10)and a type 2 diabetes model group(n=42).The latter were overfed with a high-sugar,high-fat and high-energy diet for 4 weeks,then 30ms/kg of streptozotocin was injected intraperitoneally to create a model of type 2 diabetes.Thirty diabetic rats were then allocated at random into a diabetes control group,a low intensity exercise group and a moderate intensity exercise group with 10 in each group.The treadmill exercise was administered to the animals in the low and moderate exercise groups accordingly.Results Compared with the normal control group,plasma AGEs increased significantly in the diabetes control and moderate intensity exercise groups.Compared with the diabetes control group,AGEs in the lower intensity exercise group were significantly lower.Compared with the moderate intensity exercise group,plasma AGEs in the low intensity exercise group were somewhat lower,but not significantly.Conclusion Aerobic exercise can reduce plasma AGE levels in rats with a model of type 2 diabetes.The effect is probably related to decreasing excessive blood glncose and the exercise intensity.

Pathogen of Hospital Acquired Pneumonia in General Ward / 中华医院感染学杂志

OBJECTIVE To investigate the pathogens of hospital acquired pneumonia(HAP) in the general ward of our hospital to provide the basis for clinical experiential medication.METHODS The bacteria of the 62 patients with HAP whithout organ dysfunction in the general ward of our hospital between Jan 2005 and Apr 2008 was analyzed.RESULTS The main pathogens followed by Klebsiella pneumoniae(29.03%),Escherichia coli(22.58%),Staphylococcus haemolyticus(16.13%),S.epidermidis(12.90%),Pseudomonas aeruginosa(8.06%) and S.aureus(4.84%).Gram-negative bacilli showed better sensitivity to imipenem,piperacillin/tazobactam and cefepime(91.89-81.08%);Gram-positive cocci had lower resistance to vancomycin and rifampin(100.00-92.00%).CONCLUSIONS Hospital-acquired pneumonia in the general ward can be cured by appropriate commonly used antibiotics.

ANCA-neagtive pauci-immune crescentic glomerulonephritis / 中国实用内科杂志

Objectives To study the clinical and pathological features of patients with ANCA-negative pauci-immune crescentic glomerulonephritis.Methods ANCA was detected and the clinical and pathological features were analyzed in 33 patients with pauci-immune crescentic glomerulonephritis.Results Of the 33 patients with pauci-immune crescentic glomerulonephritis, 15(45%) were ANCA negative, which accounted for 15% of the patients with crescentic glomerulonephritis. Of the 15 patients with negative ANCA,9 had multi-system involvement and 6 were clinically limited to kidney only. Renal biopsies showed small vessel vasculitis in 2 patients. After intensive immunosuppressive therapy, one out of thirteen patients was cured,six achieved clinical remission,while the other 6 became dialysis dependent.Conclusions The clinical and pathological features of the patients with ANCA-negative pauci-immune crescentic glomerulonephritis are similar to those with ANCA-positive,while the ages of these patients are younger and the prognosis poorer.

Eosinophilic hyperplasia lymphogranuloma associated with nephrotic syndrome / 中华肾脏病杂志

To explore the relationship between eosinophilic hyperplasia lymphogranuloma (ELG) and nephrotic syndrome (NS). Methods 3 cases of ELG associated with NS were collected. The specimen of ELG and renal biopsy were confinned by pathological method, and clinical characteristic, therapeutic course and follow up were summarized. Results Two cases were ELG associated with minimal changes disease (MCD), another was early membranous nephropathy (MN) . ELG and NS were cured by prednisone therapy. Conclusion About 12% of ELG may be associated NS. The pathogenesis of ELG, MCD and MN are similar, and curative effect occured by same therapy. Suggesting that, they are identical allergic disease caused by one pathogeny.

Clinical features and prognostic factors of chronic glomerulonephritis with malignant hypertension / 中华肾脏病杂志

Objective To find out the clinical characteristics and prognostic risk factors of malignant hypertension (MHT) with pre existed chronic glomerulonephritis.Method The clinical and renal pathological data of 38 chronic glomerulonephritis patients with MHT hospitalized in our department from 1990 to 2002,and the associated factors for renal prognosis were analyzed. Results All the patients suffered from chronic glomerulonephritis.The ratio of male to female was 3 75∶1.The average age was (29 5?7 74)years old. The rates of recognition, therapy and control of hypertension before MHT onset were 75 7%, 13 5%and 5 4%respectively. IgA nephropathy was the most common pathological type.Of 38 cases,3 maintained normal renal function, 6 presented acute renal failure,13 presented chronic renal failure, and 16 had acute attack based on chronic renal failure. Twenty four patients were followed up for 1～6 months after antihypertensive therapy and renal function of 10(41 7%) was improved. 1 year renal survival rate of 20 patients was 55%. The analysis of risk factors showed that those patients who were possessed of positive hypertension family history(P=0 03), high SBP/DBP levels(P=0 023,0 047), and high scores of chronic index of renal pathology(P=0 032) had worse prognosis. The level of highest serum creatinine and the scores of chronic index of renal pathology were associated with 1 year renal survival(P=0 031,0 037).Conclusions MHT occuring in young patients with chronic glomerulonephritis is not rare, which becomes an important reason inducing rapidly decrease of renal function, especially in patients with IgA nephropathy. Actively antihypertensive therapy is helpful for renal function recovery. The low rates of recognition, therapy and control of pre existed renal hypertension may play key roles in the development of MHT. It is important to recognize and treat the hypertension at early stage of renal disease to improve the renal survival.